Cholera is a bacterial disease that affects the intestinal tract (Cholera, Medical College of Wisconsin). The bacterium responsible for cholera is called Vibrio cholera. Robert Koch discovered Vibrio cholerae in 1883 during an outbreak in Egypt (Handa, 2007). According to Handa, the organism is a comma-shaped, gram-negative aerobic bacillus whose size varies from 1-3 µm in length by 0.5-0.8 µm in diameter. Its antigenic structure consists of a flagellar H. antigen and a somatic O. antigen. The differentiation of the latter allows for separation into pathogenic and nonpathogenic strains. V cholerae O1 and V cholerae O139 are associated with epidemic cholera

Vibrio cholera is passed in the feces and is spread by either eating or drinking food or water contaminated by fecal waste or an infected person (Cholera, Medical College of Wisconsin). Therefore, the disease typically occurs in underdeveloped counties that lack adequate water supplies and safe sewage disposal. In fact, there hasn’t been any major outbreak of cholera in the United States since 1911, although there were some sporadic cases between 1973 and 1991 that were caused by the consumption of raw shellfish or shellfish that had been either improperly cooked or re-contaminated after proper cooking (Vibrio cholerae Serogroup O1, U.S. Food and Drug Administration).

Cholera Symptoms and Diagnosis

Cholera has a short incubation period, from less than one day to five days after exposure (Cholera, World Health Organization) According to the Mayo Foundation (Cholera symptoms), only about ten percent of people infected with cholera actually develop signs and symptoms which may include severe, watery diarrhea, nausea and vomiting, muscle cramps from the loss of salts such as sodium, chloride and potassium, rapid dehydration, and hypovolemic shock if low blood volume causes a drop in blood pressure and a reduction in the amount of oxygen reaching tissues. Children with cholera may experience these symptoms as well as extreme drowsiness or coma, fever, and convulsions.

If cholera is not treated, the disease can quickly become fatal (Cholera complications). Losing large amounts of fluids and electrolytes can lead to death in only two to three hours. In less severe cases, people without treatment can die of dehydration and shock within 18 to 48 hours after the first cholera symptoms. In addition to shock and sever dehydration, the most serious complications of cholera include hypoglycemia, hypoklemia and kidney failure.

The Mayo Foundation (Cholera tests and diagnosis) states that a test of the stool sample for cholera is used to confirm the disease. Also, there are rapid cholera dispstick tests for quicker diagnosis.

Cholera Treatment

Despite the seriousness of the disease if not treated, cholera is not a difficult disease to treat and most people recover well with the prompt administration of oral rehydration (prepackaged mixture of sugar and salts to be mixed with water and drunk in large amounts) to replace lost fluids (Centers for Disease Control and Prevention). In more severe cases, intravenous administration of fluids may be required. Additionally, the Centers for Disease Control and Prevention states that antibiotics may shorten the course and diminish the severity of the illness.

Immediate treatment is critical for a successful outcome because death from cholera can occur within just a few hours. Without rehydration, approximately half the people with cholera die according to the World Health Organization (Cholera). However, when treated promptly, the number of fatalities drops to less than one percent.

Cholera Prevention

To prevent cholera, the Centers for Disease Control and Prevention, recommends that travelers to parts of Africa, Asia, or Latin America where epidemic cholera is occurring take the following measures:

Drink only water that you have boiled or treated with chlorine or iodine. Other safe beverages include tea and coffee made with boiled water and carbonated, bottled beverages with no ice.

Eat only foods that have been thoroughly cooked and are still hot, or fruit that you have peeled yourself.

Avoid undercooked or raw fish or shellfish, including ceviche.

Make sure all vegetables are cooked avoid salads.

Avoid foods and beverages from street vendors.

Do not bring perishable seafood back to the United States.

Although there is an oral vaccine available to prevent cholera called Dukoral, the Centers for Disease Control and Prevention does not recommend it for most travelers and the vaccine is not available in the United States.

Summary

Cholera is an acute, diarrheal illness caused by infection of the intestine with the bacterium Vibrio cholerae (Centers for Disease Control and Prevention). Symptoms can become severe, even fatal without immediate treatment. Fortunately, treatment by either oral or intravenous rehydration is straightforward and effective. While the disease is obscure in the United States, it does occur in parts of Africa, Asia and Latin America where travelers must take precautions to make sure their water and food is safe.

Bibliography

Centers for Disease Control and Prevention. http://www.cdc.gov/nczved/dfbmd/disease_listing/cholera_gi.html

Cholera. Medical College of Wisconsin. http://healthlink.mcw.edu/article/954988124.html

Cholera. World Health Organization. http://www.who.int/topics/cholera/en/

Cholera complications. MayoClinic.com. http://www.mayoclinic.com/health/cholera/DS00579/DSECTION=complications

Cholera symptoms. MayoClinic.com. http://www.mayoclinic.com/health/cholera/DS00579/DSECTION=symptoms

Cholera tests and diagnosis. MayoClinic.com http://www.mayoclinic.com/health/cholera/DS00579/DSECTION=tests%2Dand%2Ddiagnosis

Handa, S. (2007, November 20). Cholera. eMedicine. http://www.emedicine.com/med/TOPIC351.htm

Vibrio cholerae Serogroup O1. U.S. Food and Drug Administration. http://vm.cfsan.fda.gov/~mow/chap7.html